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Waging the war on bacteria

It’s no secret. There is a war on bacteria happening in hospitals across the country. While superbugs are becoming part of our everyday language, there still remains a lot of public uncertainty.

On the surface, it seems odd that people would get infections while in a hospital receiving care – after all, aren’t hospitals supposed to be clean, sterile environments? In reality, the reasons why hospital-acquired infections exist are complicated.

To help us answer the question, inside sat down with Canadian infection control expert Denise Gravel.

Denise Gravel is a recognized leader in health care-associated infections with the surveillance and epidemiology division in the Centre for Communicable Diseases and Infection Control at the Public Health Agency of Canada.

inside: What is a hospital-acquired infection?DG: A hospital-acquired infection (HAI) (or nosocomial infection) is an infection that is caught while in hospital. HAIs become particularly dangerous to patients when the bacterium causing the infection is resistant to antibiotics.

inside: What are “superbugs” and why are they prevalent in hospitals?DG: Any organism that is resistant to any antibiotic, particularly the one that is normally used to treat it, is considered an antibiotic resistant organism (ARO). Some bacteria are naturally resistant to antibiotics, while others become immune over time to the drug that is commonly used to treat it. Superbugs occur when the latter happens. A common example of a bacterium that has become immune over time to the antibiotic used to treat it is MRSA (Methicillin-Resistant Staphylococcus aureus).

Superbugs are becoming prevalent in hospitals for a couple of reasons. We are seeing more, because we are prescribing more antibiotics and the bacteria can adapt to these antibiotics over time, much faster than we can adapt the antibiotics. As well, the use of antibiotics in hospitals is highly concentrated, so the bacteria population has the opportunity to become more resistant in a hospital than it does in other environments.

inside: Why do people get infections while staying in hospitals?DG: While bacteria can be found anywhere, hospitals provide a better environment for them to adapt to the antibiotics we have to treat them because of the amount of antibiotic use. As well, the patient population within a hospital is much more susceptible to these types of infections for a couple of reasons.

The first of these reasons is when people are admitted to hospitals they often undergo invasive medical procedures – things like surgery or the insertion of various medical lines that deliver medicine or provide access to the blood stream – and with any invasive procedure there is the risk of infections occurring. As the number of these procedures increases, so does the risk of infection.

The second reason is the patient population staying in hospitals today is very different than it was even 10 years ago. Ten years ago, people would have surgery and everyone who had that surgery would stay in the hospital for a set number of days. But today, people are released as soon as they are well enough to go home, so only the sickest patients are kept in hospital. These also happen to be the people most susceptible to contracting an infection because they are the most immune-compromised.

inside: How do these infections spread?DG: Each organism has their particularities, but for the large part they are spread from patient to patient through contact. Often the main route of transmission is the hands of hospital staff or visitors. For example, hospital staff care for one patient and then go on to care for another patient without washing their hands in-between.

Indirect contact can also responsible for the spread of infections. Some bacteria, like C. difficile, can survive on surfaces. In this instance, you might see the example where an infection is acquired because a contaminated patient is transferred to a new room and another patient is admitted to that first room before it’s been properly cleaned.

inside: Why can’t we outsmart these superbugs?DG: Superbugs are organisms that rapidly adapt. Bacteria multiply every 20 minutes, whereas human cells multiply only every 24 hours. What we can do is be prudent in the way we treat patients in hospital. Antimicrobial stewardship is something that most hospitals are putting in place. Through this, hospitals evaluate the appropriate use of antibiotics and ensure that patients aren’t on them for longer than they need to be.

inside: Are superbugs a problem for all hospitals across Canada, or are they specific to certain regions?DG: The Public Health Agency of Canada does surveillance on key antibiotic resistant organisms that are acquired in hospitals. Based on that data, hospitals across the country are dealing with the issue of these superbugs equally. These organisms aren’t confined by borders, so we’re seeing the majority of Canadian hospitals putting the same infection control and prevention measures in place to help combat them.

inside: What, in your opinion, can hospitals do to help reduce the volume of hospital-acquired infections (HAIs)?DG: Hand-washing – between patients and procedures – is really the best way to prevent the spread of these organisms within the hospital. Alcohol-based hand rubs are also extremely effective and should be easily accessible.

Other strategies that are known to be effective in reducing the number of HAIs include proper cleaning of rooms and equipment, antimicrobial stewardship programs, hand hygiene audits and the education of both staff and visitors. Another extremely effective tool is early detection and routine admission screening, which allow a hospital to take the appropriate precautions immediately before there is an opportunity for an infection to spread to other patients.

It’s also important to remember that as Canadians, we’re pretty lucky. Most of our hospitals have to follow a set of infection control standards in order to maintain their accreditation. Not every country has nationwide bodies in place to set hospital standards and audit practices.

inside: What steps can people take to better protect themselves from contracting HAIs?DG: For visitors, it’s important to remember that the person they are visiting may be at a greater risk for getting an infection, so they should wash their hands or use the alcohol-based hand rubs when they enter the hospital, before entering a patient’s room and again as they are leaving the hospital. Visitors should also pay attention to any signage in the hospital, as there may be additional precautions they should take. And of course, only visit when you are feeling well.

For patients, I think they are now more aware of the risks than they used to be. Most hospitals educate the patient about the various risks, including infections, before they’re admitted. Once they are admitted, we at the Public Health Agency of Canada encourage patients to ask their nurses or physicians if they’ve washed their hands – that’s the best thing patients can do. I recognize that can be uncomfortable for some people, but I personally do it at my physician appointments and even my dentist’s office and I’ve never had a bad reaction to it. It’s part of their job.

What is LHSC doing to protect patients?

London Health Sciences Centre is committed to improving health and providing high quality patient care. Preventing the spread of AROs is so important to patient safety, that the hospital has rigorous infection control practices and policies in place. These include:

Auditing tools for cleaning practices

Early identification through screening of patients

A city-wide infection monitoring program

Staff education on new Ministry of Health and Long-Term Care core teachings

Implementation of an antimicrobial stewardship program

Regular consultations with our local public health unit

Good hand hygiene is essential in preventing the spread of these antibodies. That is why LHSC runs a hand hygiene program in the hospital which includes:

Alcohol-based hand sanitizers available throughout the hospital

Hand hygiene compliance rates posted at entrances and updated monthly

Provision of hand hygiene education materials to patients and families

Encouragement of patients to ask their health care provider ‘did you wash your hands?’ before examination

The primary concern at LHSC is always the health and well-being of patients. LHSC is safe and continues to implement measures to make it safer.

Dr. Michael John, medical director of infection prevention and control at LHSC discusses what the hospital is doing to protect patients in further detail.

Common types of antibiotic resistant organisms

C. difficile is bacteria that can live in a person’s bowel or gut, along with many other kinds of bacteria without causing symptoms. It is the most common cause of infectious diarrhea in hospitals. Antibiotics used to treat infections kill many of the good bowel bacteria and allow C. difficile to grow and produce a toxin, resulting in irritation of the bowel and diarrhea. This can happen with antibiotics you have taken at home or while you are in hospital. Symptoms include watery diarrhea, fever and abdominal pain or tenderness.

Methicillin Resistant Staphylococcus aureus (MRSA) is a type of bacteria that is resistant to many antibiotics, making it harder to treat if it causes an infection. It is found more often in people who have stayed at a hospital or other health care facility such as a long-term care. Many people can carry MRSA on their bodies without causing them any problems or requiring treatment. However they can get an MRSA infection when they are more vulnerable to getting sick, like after having surgery or when dealing with a long-term illness. Some types of MRSA can cause skin infections, like pimples and boils, in otherwise healthy people.

How can I protect myself and my family?

It is important to remember that even with antibiotic resistant organisms the hospital is still a very safe place.

As a visitor:

Only come in if you yourself are feeling well

Practice good hand hygiene

Make sure your immunizations are up to date, especially your flu shot during flu season

Be careful about visiting from patient to patient

As a patient:

Familiarize yourself with the information in the patient handbook – provided during patient registration

Ensure your immunizations are up to date

Practice good hand hygiene

As staff if they have washed their hands before they examine you

Recently, Anna Leaper, an 11-year-old patient, made a sign to encourage her visitors to wash their hands before they came and visited her. If she can take infection control and prevention into her own hands, you can too!

Influenza season

The best defense against seasonal influenza is to get immunized. Vaccination is recognized as the single most effective way of preventing or lessening the severity of influenza for those at high risk of serious illness or death. Patients in hospital are at higher risk for contracting influenza infection and developing complications.

Every year, different types of influenza virus circulate. By getting immunized, you decrease your chances of becoming ill. Getting the flu shot protects you and your family from getting influenza.